British National Formulary (BNF87) March September 2024

An integral part of the UK’s healthcare infrastructure and relied on by health professionals who prescribe, dispense, and administer medicines globally.  Containing guidance on best practice in prescribing, as well as legal and ethical considerations, BNF supports safe and effective decision-making at the point of care.

Extensive content updates in the BNF 87 edition include:

New monographs for:

• Aquipta ® [atogepant] for prophylaxis of migraine
• Filsuvez ® [birch bark extract] to promote wound healing
• Omvoh ® [mirikizumab] for ulcerative colitis
• Qdenga ® [dengue vaccine] for immunisation against dengue virus infection
• Quviviq ® [daridorexant] for insomnia
• Roclanda ® [latanoprost with netarsudil] for ocular hypertension and raised intra-ocular pressure in open-angle glaucoma
• Sotyktu ® [deucravacitinib] for plaque psoriasis
• Vaxchora ® [cholera vaccine (live)] for immunisation against cholera

MHRA advice on:

• Calcium chloride, calcium gluconate: potential risk of underdosing with calcium gluconate in severe hyperkalaemia
• Direct-acting oral anticoagulants: reminder of dose adjustments in patients with renal impairment
• Febuxostat: updated advice for the treatment of patients with a history of major cardiovascular disease
• Hyoscine hydrobromide patches (Scopoderm ®): risk of anticholinergic side effects, including hyperthermia
• Isotretinoin (Roaccutane ®): introduction of new safety measures, including additional oversight of the initiation of treatment for patients under 18 years of age
• Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality
• Methotrexate: advise patients to take precautions in the sun to avoid photosensitivity reactions
• Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions
• Non-steroidal anti-inflammatory drugs: potential risks following prolonged use after 20 weeks of pregnancy
• Quinolones: reminder of the risk of disabling and potentially long-lasting or irreversible side effects, risk of suicidal thoughts and behaviour
• Statins: very infrequent reports of myasthenia gravis
• Valproate: full pack dispensing, re-analysis of study on risks in children of men taking valproate, reminder of current Pregnancy Prevention Programme requirements; information on new safety measures to be introduced in the coming months

Other significant changes include updated guidance on:

• Adverse reactions to drugs: updated information on MHRA Yellow Card scheme and medication error reporting.
• Appendix 1 interactions: pharmacodynamic effects drug groups revalidated and updated
• Benzathine benzylpenicillin, benzylpenicillin sodium: important safety information
• Carvedilol for primary prevention of decompensated cirrhosis and prevention of bleeding oesophageal varices
• Guidance for drug interactions between HIV antiretroviral therapy and contraceptives
• Erythromycin: pregnancy advice
• Management of miscarriage
• Management of obesity
• Management of otitis media with effusion
• Management of stroke
• Management of syphilis
• Prescription requirements for Schedule 2 and 3 Controlled Drugs
• Prevention of secondary cases of diphtheria
• Rabies vaccine
• Selective serotonin re-uptake inhibitors: pregnancy and breast-feeding advice
• Vaccination, general principles during pregnancy and breast-feeding
• Vaccine drug monographs: class restructure into live and inactivated monographs
• Varicella-zoster vaccine